This qualitative study reports the findings from 6 focus groups conducted at a clinic in Southern Mexico with caregivers of morbidly obese children. This study was developed with the purpose of gaining a further understanding of caregivers' perceived role in addressing their children's obesity within the family context and identifying topics that could be considered when providing health care in similar sociocultural environments. We identified that although caregivers acknowledge the role of modifiable factors in obesity prevention and treatment, they held beliefs about determinism in obesity. In addition, diet was the more frequently identified means of reducing the impact of obesity. The importance of role modeling and promoting healthy behaviors in the family context are topics that could be addressed in clinical practice.

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This study was carried out between January and April 2008 with 14 caregivers of children younger than 5 years residing in Tizimín city, Mexico. It aimed to understand the social representations of eating and the Programa Oportunidades [Opportunity Program] held by caregivers taking into account their social and cultural context. This qualitative investigation with an ethnographic approach was based on participant observation and semi-structured interviews. Two empirical categories emerged: 1) feeding and 2) an aid. The first refers to the caregivers' representation of eating patterns of children younger than 5 years and the second reveals that the program is considered an aid, which favors and helps caregivers to meet part of their needs. The study achieved the proposed objectives since it enabled us to understand caregivers in the complex task of feeding these children and also to propose strategies in several spheres to improve infant nutrition.

RESUMENEl estudio estimó la cobertura efectiva de los servicios en salud de primer nivel de atención para el manejo de la violencia doméstica contra la mujer en tres municipios mexicanos. Se estimó la prevalencia y severidad de la violencia usando una escala validada, y la cobertura efectiva con la propuesta de Shengelia y colaboradores, con modificaciones. Se consideró atención con calidad cuando hubo sugerencia de hacer la denuncia a las autoridades. La utilización y calidad de la atención fue baja en los tres municipios analizados, siendo más frecuente la utilización cuando hubo violencia sexual o física. La cobertura efectiva en Guachochi, Jojutla y Tizimín fue de 29,41%, 16,67% y cero, respectivamente. El indicador de cobertura efectiva tiene dificultades para medir eventos y respuestas no se fundamentan en modelos biomédicos. Los hallazgos sugieren que el indicador puede ser mejorado al incorporar otras dimensiones de la calidad. DESCRIPTORES Cobertura de los Servicios de Salud Violencia contra la mujer Indicadores de servicios México RESUMOO estudo estimou a cobertura eficaz dos serviços da atenção primaria em saúde na gestão da violência doméstica contra as mulheres em três cidades mexicanas. Estimou-se a prevalência e a gravidade da violência doméstica por meio de uma escala validada enquanto a cobertura eficaz foi obtida por meio da proposta de Shengelia e colaboradores, com algumas alterações. O atendimento foi considerado de qualidade quando houve a sugestão de fazer a denúncia às autoridades. O uso dos serviços e a qualidade do atendimento foram baixos nos três municípios analisados, sendo mais frequente a utilização do serviço quando houve violência sexual ou física. A cobertura efetiva em Guachochi, Jojutla e Tizimin foi de 29,41%, 16,67% e zero, respectivamente. O índice de cobertura eficaz apresentou dificuldade em medir desfechos reais e respostas não baseadas em modelos biomédicos. Os resultados sugerem que o indicador pode ser melhorado pela incorporação de outras dimensões da qualidade do atendimento. DESCRITORES Cobertura de Serviços de Saúde Violência contra a mulher Indicadores de serviços México ABSTRACTThe study estimated the effective coverage of health services in primary care for the management of domestic violence against women in three municipalities in Mexico. We estimated the prevalence and severity of violence using a validated scale, and the effective coverage proposed by Shengelia and partners with any modifications. Quality care was considered when there was a suggestion to report it to authorities. The use and quality of care was low in the three municipalities analyzed, used most frequently when there was sexual or physical violence. Effective coverage was 29.41%, 16.67% and zero in Guachochi, Jojutla and Tizimín, respectively. The effective coverage indicator had difficulties in measuring events and responses that were not based on biomedical models. Findings suggest that the indicator can be improved by incorporating other dimensions of quality. DESCRIPTORS Health Service...

Background:The World Health Organization (WHO) estimates that 25% of global morbidity and one-third of childhood morbidity may be attributable to environment. Low and high-income countries displayed different environmental risks. Mexico demonstrates the necessity for creating a national environmental health program. In southeastern Mexico, Tixméhuac, is a Mayan community with a high marginalization degree and social backwardness. The main childhood morbidities are acute and chronic diseases.Objective:The aim of the study was to recognize environmental risks for children’s health in Tixméhauc, Yucatan State.Methods:A total of one hundred children under five years old participated. To identify the environmental risks at home, items from the Green Sheet Guidance (WHO), Salamanca General Survey and Environmental Clinical History were used. To know the prevalence of respiratory diseases and asthma, the International Study of Asthma and Allergies in Children (ISAAC) survey was used. Potentially hazardous sites were identified partially using the Methodology for Identification and Evaluation of Health Hazards in Contaminated Sites from the Pan American Health Organization (PAHO).Findings:The low stature of, malnutrition, presence of wheezing and asthma symptoms in children were higher than expected. The suspected cases of parasitosis and vector-borne disease occurred in 50% of the children. Indoor air quality perception was associated with respiratory pathology history; housing quality was related to suspected cases of vector-borne diseases; drinking water quality was linked to suspected cases of parasitosis. Risk areas in the community include agricultural activity, which has led to deposits of empty containers of agrochemicals and electronic waste among solid waste dump.Conclusion:This study presents observed environmental risks to children in a low development country and in developing countries. The community has a low perception of the environmental risk. The need for public health programs reducing risks to children’s environmental health is imperative.

PalaBraS clavEBeneficiarios; comedores comunitarios; Alimentación; México. resumen Objetivo: Evaluar las instalaciones y servicios en los comedores comunitarios e identificar percepciones y propuestas del personal y beneficiarios respecto al programa, en Tizimín, Yucatán, México. Métodos: enfoque mixto para datos cuantitativos, se utilizaron instrumentos que evalúan condiciones e higiene, participaron 41 cocineras y 177 beneficiarios; para datos cualitativos, guía de entrevista semiestructurada, participaron 15 cocineras y 12 beneficiarios. Para el análisis cuantitativo se utilizó el paquete estadístico SPSS ® versión 19 y el programa Excel ® versión 2007; para el análisis cualitativo el sistema de categorización de datos. Resultados: Las condiciones de higiene e infraestructura no son adecuadas, las dietas no cubren las calorías para cada grupo de edad; resultados cualitativos: los menús contienen alimentos saludables pero la cantidad no es la ideal, para las cocineras y beneficiarios el programa es bueno, pero sugieren mejoras en las instalaciones y los materiales. Conclusiones: Los resultados cuantitativos y cualitativos concuerdan, se sugiere mejorar los espacios para cumplir con las normas básicas de funcionamiento. assessment of the communitarian dining facilities in Tizimin, Yucatán, México: staff and beneficiaries perceptions and proposalsAbstract Objective: To assess installations and services in the communitarian dining facilities, and identify staff and beneficiaries perceptions and proposals regarding the Tizimín program, Yucatán, México.

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